Just What the Flu Costs the Healthcare System

Investigators wanted to see just how likely those 65 and older are to contracting influenza and what that costs the healthcare system. They looked at data in the claims database in IQVIA ParMetrics Plus in flu seasons from October 1, 2012 to March 1, 2019. The investigators work of IQVIA, which is a company specializing in health information technology and clinical research. Their study (“Health Resource Burden of Influenza Among the Elderly with Underlying Conditions in the United States”), which was unveiled at ID Week, concludes: “Hospitalizations, ED visits, and total healthcare costs are elevated in the elderly after evidence of medically-attended influenza, but to varying degrees depending on baseline comorbidities. Continued efforts to reduce influenza burden in high-risk populations are needed.”

The investigators used the earliest date of influenza diagnosis as the index date and patients had to have evidence of renal, pulmonary, or cardiovascular disease before the index date. Patients had to have been continuously enrolled for a year or more in the database and the data collected were from 30 days or more after the follow-up index. The investigators identified medically attended flu cases by primary influenza diagnostic codes or if the patient had been tested for flu within 14 days.

“Influenza [patients] were 1:1 propensity score matched to [patients] without influenza using baseline demographic and clinical characteristics and baseline healthcare costs,” the study states. “All-cause hospital and emergency department (ED) visits and total healthcare costs during follow-up (30-day and in the index influenza season) were compared in the matched cohorts.”

Investigators found that the mean healthcare cost for treating elderly influenza patients per patient per flu season ranged from $3,299 to $12,398 higher than the costs for treating patients with congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease, and stage 5 renal disease. In addition, patients with influenza had 3 to 7 times higher 30-day hospitalization rates compared to patients without influence. The breakdown: congestive heart failure (41% vs. 8%), chronic obstructive pulmonary disease (35% vs. 6%), coronary artery disease (23% vs. 4%), and stage 5/end stage renal disease (ESRD)/dialysis (44% vs. 13%; all p< .05.

“Hospital and ED visit rates in the influenza season were 2 to 3 times higher in [patients] with vs. without influenza; ED visit rates were 49% vs. 23%, 44% vs. 18%, 37% vs. 14%, and 60% vs. 28%” for patients with congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease, and stage 5 renal disease respectively, the investigators note.

Data from the Southern Hemisphere seem to indicate that the flu season may be a mild one this year, partly because the things people do to protect themselves from COVID-19—social distancing, hand hygiene, masking—seem to work particularly well against the flu.

However, Bilal Naseer, MD, the infectious disease specialist, at the not-for-profit healthcare system CommonSpirit Health, recently told Infection Control Today® in a Q&A that it is still way too early to let our guard about the flu. The flu season “still has a long way to go,” Naseer said. “Sacramento, where I am located, we get the majority of our flu peaks around Christmas time or New Years, sometimes going into January and February of next year. I think we still have a way to go, but I think the importance of vaccine against influenza cannot be overemphasized because we know respiratory viruses attack weaker hosts. If a lot of patients actually get influenza and never really truly get ill, but if they get vaccinated, they will stay healthy and their immunity will be the best bet against an infection for which you don’t have the vaccine, such as SARS-CoV-2.”

Naseer also noted that mortality figures for COVID-19 have gone down dramatically because healthcare providers have a better handle on how to handle it, even though there’s no cure yet. “Because COVID-19 numbers and mortality are trending down, and there is awareness in the public about the importance of prevention, I expect us to see milder COVID-19 and possibly a smaller influenza season this year,” Naseer said.